- Pregnancy Outcome in Korean Women with Gestational Diabetes Mellitus Diagnosed by the Carpenter-Coustan Criteria.
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Hak Chul Jang, Young Min Cho, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Moon Young Kim, Jae Hyug Yang, Son Moon Shin
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Korean Diabetes J. 2004;28(2):122-130. Published online April 1, 2004
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 Abstract
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The American Diabetes Association recently proposed the Carpenter-Coustan criteria for the diagnosis of gestational diabetes mellitus(GDM) based on the results of the Toronto Tri-Hospital Study. The prevalence of GDM in Korean women increased, on average, by 60% when the Carpenter-Coustan criteria were applied. However, the pregnancy outcome of Korean women with GDM with regard to the Carpenter-Coustan criteria tremains to be reported. The pregnancy outcomes of those Korean women with GDM by the Carpenter- Coustan criteria, but not by the NDDG criteria were assessed. METHODS: In this study, a total of 2776 pregnant women underwent universal screening for GDM, between January 1993 and December 1994, as recommended by the Third International Workshop-Conference on Gestational Diabetes Mellitus with minor modifications. The primary pregnancy outcomes were preeclampsia, premature delivery, delivery by C-section, birth weight and LGA infants. RESULTS: Of the 2776 women, 656 screened-positive for GDM. Of these, 37 and 74 had GDM by the Carpenter-Coustan and NDDG criteria, respectively. With increasing glucose intolerance, there was a stepwise increase in premature deliveries, deliveries by C-section and preeclampsia from those screening negative to GDM by the NDDG criteria, with a similar trend for the frequency of LGA infants. The LGA infant screening-negative and positive were 13.5 and 16.1%, but those with a normal glucose tolerance were 27.0 and 33.8% in those screening positive to GDM by the Carpenter-Coustan and NDDG criteria, respectively(P<0.001). CONCLUSION: Our study demonstrated that increasing glucose tolerance was associated with increasing frequencies of adverse pregnancy outcomes in Korean women. The maternally complicated and LGA infants were significantly higher in women with GDM by the Carpenter-Coustan criteria. Thus the Carpenter- Coustan criteria are recommended for the diagnosis of GDM in Korean Women.
- Effect of Self-monitoring of Blood Glucose on Pregnancy Outcome in Women with Mild Gestational Diabetes.
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Hak Chul Jang, Jeong Eun Park, Chang Hoon Yim, Ho Yeun Chung, Ki Ok Han, Hyun Koo Yoon, In Kwon Han, Moon Young Kim, Jae Hyug Yang, Mi Jung Kim, Sun Young Ko, Yeon Kyung Lee
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Korean Diabetes J. 2001;25(1):93-102. Published online February 1, 2001
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Abstract
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Self-monitoring of blood glucose (SMBG) and intensive therapy with insulin demonstrated to have a positive effects in the reduction of the neonatal complications in women with gestational diabetes (GDM). However the utility of SMBG in the mild GDM who does not requiring insulin has not been formally reported. Therefore, to evaluate the effectiveness of SMBG in the management of mild GDM, we compared the pregnancy outcome and the postpartum glucose tolerance of women who monitored their glycemic control by SMBG to those of women who monitored by laboratory glucose test at each office visit during pregnancy. METHODS: We studied 185 women diagnosed as a GDM by NDDG criteria and their fasting glucose concentration < 5.8 mM. All subjects had singleton pregnancy,and no medical diseases that may affect fetal growth, and were certain of gestational age by early ultrasonography. They were treated with an identical GDM management protocol except glucose monitoring. One hundred five women were monitored by laboratory glucose test at each office visit (office group) and 80 women were monitored by SMBG (SMBG group). Pregnancy outcome including rates of cesarian section, obstetric complication, LGA infant and glucose tolerance status at postpartum were compared between two groups. RESULTS: The age, height, prepregnancy weight, weight at delivery and parity were not significantly different between the two groups. Fasting, 1-h, 2-h glucose concentration during the diagnostic test of GDM in SMBG group were similar to those of office group. However, 3-h glucose concentration of office group was 0.3 mM higher than that of SMBG group. The rate of primary cesarian section, preterm labor and pregnancy-induced hypertension of SMBG group were similar to those of office group. The mean postprandial 2-h glucose concentration of office group measured at each office was 0.5 mM higher than that of SMBG group. Although 5% of office group were treated with insulin, 24% of SMBG group were requiring insulin therapy. The birth weight and LGA infant rate of office group were 3403 432 g and 28%, those were heavier and higher than those of SMBG group (3169 447 g, 13.8%). The 90% of office group and 84% of SMBG group were performed 75 g oral glucose tolerance test at postpartum 6-8 weeks. There was no significant difference in rates of diabetes and IGT between office and SMBG group (9.5%, 11.6%; 7.5%, 9.0% respectively). CONCLUSIONS: This study demonstrated that SMBG is very seful in early detection of maternal hyperglycemia and lowing the postprandial glucose, as well as reducing the rate of LGA infants in women with mild GDM.
- Clinical Characteristics and Pregnancy Outcome in Korean Women with Type I & Type II Diabetes Mellitus.
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Yoon Huh, Dong Won Suh, Hak Chul Jang, Chang Hoon Yim, Ki Ok Han, Hyun Ku Yoon, In Kwon Han, Hun Ki Min, Eun Sung Kim, Moon Young Kim, Hyun Mi Ryu, Sung Won Yang, Hae Kyoung Han
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Korean Diabetes J. 1998;22(3):353-362. Published online January 1, 2001
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The prevalence of diabetes is gradually increasing iin Korean. Moreover, the prevalence of pregnancy complicated by established diabetes seems to be increasing. During the past decades, advances in the diabetes care as well as advances in fetal surveillance and neonatal care, have continued to improve pregnancy outcome of women with diabetes. However, the incidence of congenital anomalies and spontaneous abortion as well as the perinatal morbidity in the women with diabetes are still higher compared to those of the general population. In this study, we estimated the prevalence of prepmncy complicated by both type 1 and type 2 diabetes and described the clinical characteristics and outcome of diabetic pregnancies. METHODS: We analyzed data from four sources: 1) the mother(type and duration of diabetes, diabetic complication, preconceptional care), 2) obstetric outcome(method of delivery, obstetric complication), 3) neonatal outcome(birth weight, perinatal complication, congenital anomaly), 4) glycemic control during pregnancy, of women with pregestational diabetes delivered newborns at Samsung Cheil Hospital from 1992 to 1995. RESULTS: During the study period, 34 singleton infants were delivered by the 28 women with diabetes. The diabetic pregnancy was present in 0.14% of total deliveries in Samsung Cheil Hospital. Patients with IDDM comprised 18%(6/34) of total diabetic pregnancies, 82%(28/34) had NIDDM. The duration of diabetes was 6.3 and 2.1 years in patients with IDDM and NIDDM, respectively. Two IDDM patients presented with proliferative retinopathy, and 3 background retinopathy, one in IDDM and 2 in NIDDM. Three patients with IDDM and 2 patients with NIDDM had diabetic nephropathy. Insulin requirement during pregnancy was increased about 2 times at the time of delivery when compared to the initial in women with IDDM and NIDDM. Preeclampsia was the most common obstetric compliications, which were more frequently observed in women with diabetic complications. LGA was present in 43% of women with NIDDM. One infant of mother with NIDDM, delivered at 28 weeks gestation, was died because of respiratory distress and one infant of mother with IDDM had a congenital heart disease(TOF). Only 3 patients scught for the preconceptional care before pregnancy. CONCLUSION: Pregnancies complicated by diabetes was more frequent than was expected, even though it was much less than the rates in North America. Only 9% of women with diabetes had preconceptional care before pregnancy. The importance of planned pregnancy and prepregnancy counseling should be addressed in women with diabetes of child bearing age.
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